Ketones in Urine: Facts You Need to Know

Ketones in the UrineIn healthy individuals, carbohydrates are the body’s main energy source. When the body is unable to use carb sources like glucose, it breaks down fat for energy—this commonly occurs when there is not enough insulin to use glucose for energy.

When there is too little insulin, ketones will likely show up in the blood or urine. Ketones are the chemical byproduct produced when the body burns fat for fuel.

Ketonuria is the medical condition when ketones in urine are present. High ketone levels, in combination with high blood glucose levels (hyperglycemia), can lead to a dangerously toxic body and the condition known as diabetic ketoacidosis.

What Is Ketoacidosis and Ketonuria?

Ketoacidosis or ketonuria can occur when a type 1 diabetic doesn’t take their insulin. It also occurs when insulin-dependent diabetics fail to meet the higher insulin demands from stress, injuries, or an illness. Ketoacidosis and ketonuria may also occur in type 2 diabetics who are sick and insulin-deficient.

Ketoacidosis can be the first sign of diabetes, especially when there hasn’t been a formal diagnosis. Uncontrolled diabetes may have ketones in the urine or blood without ketoacidosis, when the diet is very low in calories, nutrients, or carbohydrates. Ketones in urine can be produced from weight loss, hyperthyroidism, prolonged vomiting, or excessive aspirin use.

Diabetics may also opt for the ketogenic diet, which is low in carbohydrates and calories. In this case, the body may compensate for the lack of carbs and calories by breaking down fat to use ketones for energy. When there is enough insulin, ketoacidosis should not be a problem with the ketogenic diet.

Why Should You Test for Ketones?

Ketoacidosis is a medical emergency, and it is potentially life-threatening. Progressive ketoacidosis can lead to metabolic problems; however, it can even lead to a coma or death. Ketoacidosis is associated with alcoholism, fasting, starvation, ingestion of the toxic chemical isopropanol, and high-protein diets.

Diabetics who take insulin and have blood sugar levels higher than 14 millimoles per liter (mmol/L) should definitely test for ketones on a regular basis. A home ketone test will be able to check for ketones in urine or blood.

There are several reasons why a ketone test is necessary:

  • It is considered a convenient method to monitor diabetics, especially when they are sick.
  • It is also useful for people on a high-fat or low-carbohydrate diet to monitor ketone levels.
  • Ketone testing is also used for someone that cannot eat due to fasting or eating disorders like anorexia. The person may also experience symptoms of diarrhea or frequent vomiting.
  • Pregnant women with diabetes or gestational diabetes should also be monitored with a ketone test. Gestational diabetes is a form of diabetes that sometimes develops during pregnancy, and it often disappears when the baby is born.

When Do You Test for Ketones?

It is best to consult your doctor or nurse to help you understand when you should check for ketones in your urine. Your health history and symptoms are the best indications of whether ketone urine testing is necessary.

When is it a good time for a ketone urine test? Pregnant women may be advised to monitor ketone levels any time the blood glucose reading jumps above 200 mg/dl, or before breakfast. You should also test for ketones in urine when you experience one or more of the following symptoms associated with ketoacidosis or ketonuria:

  • Your blood sugar number reads over 300 mg/dl.
  • You have fruity-smelling breath.
  • You experience hyperventilation or trouble breathing.
  • You experience dry mouth and excessive thirst.
  • You experience frequent urination.
  • You lack energy and feel mentally confused.
  • You have dilated pupils.
  • You are sick or injured. (Injuries, infections, and illnesses are causes of sudden high blood sugar levels.)
  • You experience abdominal pain, nausea, or vomiting.
  • You have flushed or dry skin, or your skin lacks color.

When any of these symptoms persist, it is likely that ketone levels are high or above average.
testing ketones in urine

How to Test for Ketones

The ketone blood test is often the most accurate method for measuring ketones; however, a urine test is most recommended by doctors. The ketones in urine tests are often measured as “spot tests.” Ketone urine kits are often available at the drug store. The kit will contain chemical-coated dipsticks that react with the ketones.

1. How to Perform the Urine Test

Simply place the dipstick in the urine sample. If the dipstick changes color, then there are ketones in the urine. The results are then compared with a color chart that is supplied in the kit. Your doctor may also give you a clean-catch kit that will help you obtain more accurate results. The kit contains sterile wipes and a cleansing solution.

2. How to Prepare for the Test

Your doctor may tell you to avoid medications or supplements that may falsify the test, such as glucocorticoids, levodopa, phenazopyridine, valproic acid, inositol, metformin, methionine, captopril, and ascorbic acid (vitamin C).

3. How the test feels

You should feel no discomfort with the urine ketone test, and it only involves urination.

What Do the Results Mean?

The next step is to interpret your ketone results:

  • A normal ketone result is under 0.6 mmol/L. Normal may at times indicate a negative test result.
  • A result of 0.6 to 1.5 mmol/L is an indication that there are trace amounts of ketones. This may also read as less than 20 milligrams per deciliter (mg/dl). Basically, there are more ketones than normal. It may be a sign that ketones are starting to build up. The test should be taken again in a few hours to see if the number changes.
  • A result of 1.6 to 3.0 mmol/L is an indicator of high ketone levels, and ketoacidosis or ketonuria may be risk factors. It may also read as a moderate score of 30 to 40 mg/dl.
  • Above 3.0 mmol/L is considered a dangerous ketone level, and immediate attention is required. A high score is more than 80 mg/dl.

Also, make a note that exercise is never recommended when ketones in urine reveal to be moderate or high; overall, moderate to high ketones in urine are a dangerous sign that diabetes is uncontrolled, and your doctor should be informed immediately. It is also good practice to keep track of your ketone urine test results to help your doctor in the process.

Keep in mind that abnormal urine ketone test result may also be a result of burns, fever, acute or severe illness, anorexia, fasting, high protein or low carb diets, long-term vomiting, starvation, hyperthyroidism, lactation, or pregnancy.

How to Avoid Ketonuria or Ketoacidosis

The best way to avoid high levels of ketones in urine is by controlling blood sugar levels. A healthy diet is the best approach for blood sugar control. A good first step is the consumption of low-glycemic index (GI) foods. These foods have a GI of 55 or below. Glycemic load (GL) foods will also be the amount of carbs per serving in the particular food. Low GL foods will be 10 or less. It is important to note that foods that are low GI may not necessarily be low GL.

There are a variety of low glycemic vegetables such as:

    • Asparagus
    • Cucumber
    • Kale
    • Swiss chard
    • Broccoli
    • Cauliflower
    • Collard greens
    • Radishes
    • Artichokes
    • Eggplant
    • Celery
    • Peppers
    • Cauliflower
    • Leeks
    • Daikon
    • Okra
    • Turnip greens
    • Brussels sprouts
    • Watercress
    • Zucchini
    • Spinach
    • Arugula

Low glycemic fruits include:

    • Apples
    • Cherries
    • Oranges
    • Peaches
    • Pears
    • Plums
    • Grapes

Low GI grains include quinoa, amaranth, buckwheat, oats, spelt, and wild rice. They are also considered medium GL, and it is best to pair them with low glycemic vegetables to help balance blood sugar levels.

Type 1 diabetics should remember to inject insulin at appropriate times to avoid the buildup of ketones.

WANT MORE? Sign up for latest health news, tips and daily health eAlert from the experts you can trust for FREE!

More Perspectives

Our Readers' Comments

  • "I do appreciate your newsletter and read It cover to cover. I like how you give both sides of the story and the pros and cons."

    E.M., Riverdale, MD

  • "Excellent information."

    R.M., Clemson, SC

  • "So far I've gained info---I love it and am a slow reader so it takes time enjoying all the good info---thank you for asking."

    R.V., Hamburg, NY

  • "I truly enjoy the information in the recent reports. These are life-saving tips and data I have used for myself and family. Thank you for your dedication to getting the facts to us."

    C.M., Auburn Hills, MI

  • "I am enjoying the Vitamin Doctor newsletter. Will probably subscribe to it forever. "

    E.F., Fort Myers, FL

  • "I really enjoy most of your newsletters."

    D.N., Cedar Grove, WI

  • "I very, very much thank God for your caring, knowledgeable and selfless mission to help folks keep or regain our health. It is not veiled your concern for our welfare. Thank you."

    M.R., Lubbock, TX

  • "Having had a heart attack last year I really appreciate your articles on heart health. Very informative. Keep it up."

    S.G., Winnipeg, MB

  • "I have enjoyed reading Doctor's Health Journal and it has enlightened me on several issues!"

    T.L., Somerset

  • "I look forward in reading my Chinese Medicine Healing Miracles newsletter. It gives me a better look at things beside the chemicals that our government is trying to pump into us and all the side effects. I like to go natural as much as I can."

    M.B., Liberty, TX

  • "I enjoy reading all that you put out…"

    R.Z., Encino, CA

  • "Keep up the good work! Your newsletter are interesting and informed and like getting them."

    J.B., Queens, NY

  • "It is really an eye opener. All information is much appreciated for this times when everything we do and don't do has it consequences in our health."

    R.A., Westchester, NY

  • "Thanks, I really do like your newsletter. Valuable."

    B.T., Vallda, Sweden

  • "I enjoy your newsletter, and great believer in alternative remedies and cures"

    M.D., CA

  • "Thanks for the information you are providing. It is educational a learning experience."

    L.W., New Orleans, LA

  • "Yes i have enjoyed your newsletter and look forward to each issue."

    E.B., Carney’s Point, NJ

  • "Very informative. Thanks for all the healthy tips. My blood pressure has been high. Needed info on good veggies & herbs, along with doctor visit. Thank you."

    L.F., Staten Island, NY

  • "I enjoy reading the everyday advice from all the Doctors with different approach for our health and I thank all of you Doctors for you good intentions. I hope many people like me take advantage and follow your advice and get the benefits."

    L.F., Levittown, NY

  • "I am enjoying learning and receiving this great information ."

    K.P., Carmel, IN

  • "I have been impressed with your newsletter alongside of other health blogs as there is developing in this arena an informed consensus of basic nutritional principles that our culturally stressed diets need for a realistic return to good health individually and as a society."

    L.B., Monticello, KY

  • "You have a great and helpful publication!!!"

    B.J., Dayton, OH

  • "I'm not even a quarter of the way through "12 Kitchen Cures to Slash Your Blood Pressure" and found three (remedies) to work as stated. It seems like one in and of itself is the one thing that knocks of as many as 10 points from each side of my BP."

    T.S., Burbank, CA

  • "Thanks for the wonderful information!"

    L.U., Bradenton, FL

  • "Some of the articles I found informative, but the majority I already knew. For the people who are just learning about natural ways of keeping healthy, a subscription to your newsletter is a good idea."

    T.R., Vancouver, BC

  • "I was in hospital and just started reviewing your info. I like what I have seen so far. Thank you."

    B.B., New York, NY

  • "I appreciate you sending me the Vitamin doctor newsletter they are very informative."

    P.T., Bermuda